Salvage surgery for lateral tennis elbow

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Elbow Surgery

Background:

• Lateral epicondylitis, commonly known as tennis elbow, often requires surgical intervention when conservative treatments fail.
• Previous surgical procedures for tennis elbow may not always address the underlying pathology, leading to persistent symptoms and the need for revision surgery.

Purpose of the Study:

• To evaluate the efficacy of salvage revision surgery for patients with failed prior surgical treatment of tennis elbow.
• To identify the common intraoperative findings in revision cases and determine the optimal surgical technique.

Main Methods:

• A retrospective analysis was conducted on 34 patients (35 elbows) who underwent revision surgery for failed tennis elbow treatment between 1979 and 1994.
• Patient history was reviewed, and intraoperative findings were recorded. Salvage surgery involved debridement of the extensor carpi radialis brevis tendon and scar tissue excision.
• Outcomes were assessed using a novel 40-point functional rating scale at an average follow-up of 64 months.

Main Results:

• Residual tendinosis of the extensor carpi radialis brevis tendon was present in 34 of 35 elbows.
• In 27 elbows, the pathologic changes were not previously addressed; in 7, they were incompletely excised.
• Revision surgery resulted in good or excellent outcomes in 83% (29 of 35) of the elbows.

Conclusions:

• Failure in surgical treatment for tennis elbow is often due to unaddressed or incompletely treated pathology in the extensor carpi radialis brevis tendon.
• Resection of pathologic tissue in the extensor carpi radialis brevis tendon origin is crucial for successful revision surgery.
• Release procedures that do not address the pathoanatomic changes are not recommended for revision tennis elbow surgery.